Pathologic Quiz Case 1
Gregg L. Heacock, MD; Fowzia Taqi, MD; John Biedlingmaier, MD, Baltimore, Md
A 45-year-old obese, black woman with a history of serous otitis media and nasopharyngeal lymphoid hypertrophy (biopsy specimen showing "lymphoepithelial mucosa with acute and chronic inflammation") underwent placement of polyethylene tubes for conductive hearing loss. Several months later, the patient complained of chronic postnasal drainage and constant nasal congestion. The initial biopsy specimen of a small left intranasal mass revealed an allergic polyp. A subsequent computed tomographic scan (Fig 1) showed opacification of the left frontal sinus with mucosal thickening of both ethmoid sinuses.
The patient was treated with a 14-day course of amoxicillin with clavulinic acid (Augmentin) with minimal subjective relief. After an additional 2 months' therapy with topical cortisone nasal sprays, the patient's symptoms continued.
The patient reported mild pressure and pain in the left cheek, occasional frontal headache, and occasional deep
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